Home Medizin COVID-19 deckt tief verwurzelte strukturelle Ungleichheiten auf, die sich auf die Impfaufnahme bei ACB-Gruppen auswirken

COVID-19 deckt tief verwurzelte strukturelle Ungleichheiten auf, die sich auf die Impfaufnahme bei ACB-Gruppen auswirken

von NFI Redaktion

An overview published in Vaccines recently examined the impact of low vaccine acceptance in African, Caribbean, and Black (ACB) communities on public health in high-income countries.

Study: Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review. Image Credit: SeventyFour/Shutterstock.com

Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review
. Image Credit: SeventyFour/Shutterstock.com


The severe pandemic of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a massive vaccination campaign; however, ACB communities have experienced significant negative consequences and are hesitant to receive the vaccine.

These communities are vulnerable due to health disparities, such as the higher prevalence of SARS-CoV-2 infections and hospitalizations. These disparities significantly impact the social determinants of health (SDOH), and vaccine hesitancy can lead to delayed or uncertain vaccination.

The global vaccination rate has declined; therefore, public health initiatives must adapt to current conditions and plan for future epidemics.

About the Review

In this review, researchers examined the variables contributing to low vaccine uptake in ACB individuals, focusing on healthcare in developed countries.

They attempted to find current data sources, map evidence, identify research gaps, and pinpoint existing interventions to increase vaccination rates in the study population.

The team searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, APA PsycInfo, CINAHL, Web of Science, Open Science Framework, and the Allied and Complementary Medicine databases.

They followed the Joanna Briggs Institute (JBI) model, supplemented by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) extension. This included articles published between 2020 and July 19, 2022 in English or French.

The researchers conducted the data search using the Population, Concept, and Context (PCC) framework to identify records discussing vaccine uptake among ACB residents of high-income countries as defined by the World Bank.

Evidence sources included primary studies, secondary research, abstracts, posters, conference reports, reports, and comments.

Two researchers independently reviewed the data, with a third researcher resolving discrepancies. The team used the Social Determinants of Health (SDOH) method, the Socioeconomic Model (SEM), and Thematic Mapping (TM) to analyze and interpret the data.

The TM phases included individual, intra-group, and inter-group analyses to generate descriptive, analytical, and primary themes.


Initially, the team identified 9,378 records and removed 4,246 duplicates. After title and abstract screening, they excluded 2,746 records.

Of the remaining 2,386 records subjected to full-text review, 60 suitable records were analyzed, including 24 quantitative, ten qualitative, 19 comment datasets, and seven mixed-method datasets. Most records were from the United Kingdom, Canada, and the United States.

The thematic mapping analysis highlighted four main themes: (i) Inequalities and Racism, (ii) Behaviors and Emotions, (iii) Communication and Knowledge, and (iv) Influence and Engagement.

Inequalities and racism within the healthcare system are attributed to distrust, racial stress, and institutional barriers to access. Vaccine hesitancy (VH) is associated with increased vaccine reluctance, perpetuating health disparities in Black communities.

The population structure of individuals exhibiting vaccine hesitancy reflects societal health factors such as age, housing insecurity, low income, and low education.

The number of vaccinations initiated against Blacks is lower among immigrants from other countries in the United States, with lesser incidence in the Americas and the Caribbean islands compared to Africa.

Factors such as willingness, views on vaccination, life events, and vaccine trust determine vaccine uptake. Main causes include lack of vaccination mandates, religious and political opinions, abuse, mortality exposure, and pre-existing conditions.

Abuse, mortality, and past illnesses are examples of lived experiences. Vaccine confidence encompasses skepticism, timeliness, novelty, side effects, efficacy, and safety.

Black individuals are more likely to get vaccinated because they have health issues or believe that vaccinations are the wrong strategy.

Vaccine hesitancy may stem from the desire to protect oneself, the need for school or workplace requirements, or the wish to avoid infection. To reduce vaccination rates and COVID-19 infections, governments and healthcare establishments must consider these variables.

Lack of knowledge, misinformation, and misunderstandings in Black communities all contribute to vaccine hesitancy. Black parents actively seek information about vaccinations for children, but the greatest barrier is the lack of research on short- and long-term effects.

Educational programs, trust in vaccine information, and open communication are crucial for boosting immunization rates. Fostering trust can strengthen confidence and vaccine intentions, while tailored messaging to target audiences can promote vaccination. Racism and bias, acting as structural barriers to equitable healthcare, must be addressed through culturally appealing techniques.


The study findings revealed that ACB populations had lower vaccination rates than high-income countries. Complacency, discomfort, and lack of confidence are factors contributing to vaccine hesitancy, which cannot be fully explained by past and present racism and bias.

The issue is complex and encompasses knowledge as well as psychological, economic, and organizational constraints contributing to structural injustices. High-income countries should collect race-specific data for targeted interventions and increase the number of ACB participants in vaccine trials to strengthen confidence in vaccinations.

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